The risk of falling and falling consequences in patients with atrial fibrillation receiving different types of anticoagulant drugs

    Authors

    Keywords

    atrial fibrillation, falling, anticoagulation

    DOI

    https://doi.org/10.15836/ccar2021.61

    Full Text

    Objective : To investigate predictors of falling requiring visit to emergency department in patients with non-valvular atrial fibrillation (AF) receiving different types of anticoagulants, as well as to investigate clinical consequences of falling in the same population. Patients and Methods : A total of 1,217 patients with non-valvular AF from two institutions were retrospectively evaluated. Physical examination, clinical history and medications profile were obtained from each patient at baseline. Results : Median age of our cohort was 71 years. There were 52.3% males and 86.1%patients were receiving anticoagulation at the study baseline. Freedom-from-falling 5-year rate was 81.6%. Use/type of anticoagulation was not significantly associated with the risk of falling (P=0.222), whereas higher Morse-Fall-Scale (MFS), CHA2DS2-VASC and HAS-BLED scores were significantly associated with the higher hazard of the first fall in univariate analyses. In the multivariate Cox-regression model MFS, older age, osteoporosis, higher HDL-cholesterol, higher diastolic-blood-pressure, use of amiodarone, use of diuretics, and use of short and medium-acting benzodiazepines were identified as mutually independent predictors of the first fall. A total of 93/163(57%) patients suffered a bone fracture during the fall. Type of anticoagulation significantly affected survival after the first fall (P<0.001) with patients inadequately anticoagulated with warfarin experiencing worse and patients receiving apixaban and dabigatran experienced best survival after the first fall. Conclusion : Older patients with comorbidities, taking amiodarone, diuretics, and short and medium acting benzodiazepines are under highest risk of falling. ( 1 ) Type and quality of anticoagulation do not seem to affect the risk of falling but significantly affect survival after the first fall.

    Cardiologia Croatica
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    The risk of falling and falling consequences in patients with atrial fibrillation receiving different types of anticoagulant drugs

    Extended Abstract
    Issue1-2
    Published
    Pages61
    PDF via DOIhttps://doi.org/10.15836/ccar2021.61
    atrial fibrillation
    falling
    anticoagulation

    Authors

    Ivana Jurin*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Marko LucijanićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Vedran RadonićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Tomislav LetilovićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Diana RudanORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Tomislava Bodrožić Džakić-PoljakORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Irzal HadžibegovićORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Objective : To investigate predictors of falling requiring visit to emergency department in patients with non-valvular atrial fibrillation (AF) receiving different types of anticoagulants, as well as to investigate clinical consequences of falling in the same population. Patients and Methods : A total of 1,217 patients with non-valvular AF from two institutions were retrospectively evaluated. Physical examination, clinical history and medications profile were obtained from each patient at baseline. Results : Median age of our cohort was 71 years. There were 52.3% males and 86.1%patients were receiving anticoagulation at the study baseline. Freedom-from-falling 5-year rate was 81.6%. Use/type of anticoagulation was not significantly associated with the risk of falling (P=0.222), whereas higher Morse-Fall-Scale (MFS), CHA2DS2-VASC and HAS-BLED scores were significantly associated with the higher hazard of the first fall in univariate analyses. In the multivariate Cox-regression model MFS, older age, osteoporosis, higher HDL-cholesterol, higher diastolic-blood-pressure, use of amiodarone, use of diuretics, and use of short and medium-acting benzodiazepines were identified as mutually independent predictors of the first fall. A total of 93/163(57%) patients suffered a bone fracture during the fall. Type of anticoagulation significantly affected survival after the first fall (P<0.001) with patients inadequately anticoagulated with warfarin experiencing worse and patients receiving apixaban and dabigatran experienced best survival after the first fall. Conclusion : Older patients with comorbidities, taking amiodarone, diuretics, and short and medium acting benzodiazepines are under highest risk of falling. ( 1 ) Type and quality of anticoagulation do not seem to affect the risk of falling but significantly affect survival after the first fall.